Seasonal influenza vaccination coverage among adult populations in the United States, 2005-2011.

The most effective strategy for preventing influenza is annual vaccination. We analyzed 2005-2011 data from the National Health Interview Survey (NHIS), using Kaplan-Meier survival analysis to estimate cumulative proportions of persons reporting influenza vaccination in the 2004-2005 through 2010-2011 seasons for persons aged ≥18, 18-49, 50-64, and ≥65 years, persons with high-risk conditions, and health-care personnel. We compared vaccination coverage by race/ethnicity within each age and high-risk group. Vaccination coverage among adults aged ≥18 years increased from 27.4% during the 2005-2006 influenza season to 38.1% during the 2010-2011 season, with an average increase of 2.2% annually. From the 2005-2006 season to the 2010-2011 season, coverage increased by 10-12 percentage points for all groups except adults aged ≥65 years. Coverage for the 2010-2011 season was 70.2% for adults aged ≥65 years, 43.7% for adults aged 50-64 years, 36.7% for persons aged 18-49 years with high-risk conditions, and 55.8% for health-care personnel. In most subgroups, coverage during the 2010-2011 season was significantly lower among non-Hispanic blacks and Hispanics than among non-Hispanic whites. Vaccination coverage among adults under age 65 years increased from 2005-2006 through 2010-2011, but substantial racial/ethnic disparities remained in most age groups. Targeted efforts are needed to improve influenza vaccination coverage and reduce disparities.

Influenza A (H1N1) 2009 monovalent and seasonal influenza vaccination among adults 25 to 64 years of age with high-risk conditions--United States, 2010.

BACKGROUND: Seasonal influenza vaccination has been routinely recommended for adults with high-risk conditions. The Advisory Committee on Immunization Practices recommended that persons 25 to 64 years of age with high-risk conditions be one of the initial target groups to receive H1N1 vaccination during the 2009-2010 season. METHODS: We used data from the 2009-2010 Behavioral Risk Factor Surveillance System survey. Vaccination levels of H1N1 and seasonal influenza vaccination among respondents 25 to 64 years with high-risk conditions were assessed. Multivariable logistic regression models were performed to identify factors independently associated with vaccination. RESULTS: Overall, 24.8% of adults 25 to 64 years of age were identified to have high-risk conditions. Among adults 25 to 64 years of age with high-risk conditions, H1N1 and seasonal vaccination coverage were 26.3% and 47.6%, respectively. Characteristics independently associated with an increased likelihood of H1N1 vaccination were as follows: higher age; Hispanic race/ethnicity; medical insurance; ability to see a doctor if needed; having a primary doctor; a routine checkup in the previous year; not being a current smoker; and having high-risk conditions other than asthma, diabetes, and heart disease. Characteristics independently associated with seasonal influenza vaccination were similar compared with factors associated with H1N1 vaccination. CONCLUSION: Immunization programs should work with provider organizations to review efforts made to reach adults with high-risk conditions during the recent pandemic and assess how and where they can increase vaccination coverage during future pandemics.

Seasonal influenza morbidity estimates obtained from telephone surveys, 2007.

OBJECTIVES: We assessed telephone surveys as a novel surveillance method, comparing data obtained by telephone with existing national influenza surveillance systems, and evaluated the utility of telephone surveys. METHODS: We used the 2007 Behavioral Risk Factor Surveillance System (BRFSS) and the 2007 National Immunization Survey-Adult (NIS-Adult) to estimate the incidence of influenza-like illness (ILI), medically attended ILI, provider-diagnosed influenza, influenza testing, and treatment of influenza with antiviral medications during the 2006-2007 influenza season. RESULTS: With the January-May BRFSS, among persons aged 18 years and older, the cumulative incidence of seasonal ILI and provider-diagnosed influenza was 37.9 and 5.7 adults per 100 persons, respectively. Monthly medically attended ILI and provider-diagnosed influenza among adults were temporally associated with influenza activity, as documented by national surveillance. With the NIS-Adult survey data, estimated provider-diagnosed influenza, influenza testing, and antiviral treatment were 2.8%, 1.4%, and 0.6%, respectively. CONCLUSIONS: Our telephone interview-based estimates of influenza morbidity were consistent with those from national influenza surveillance systems. Telephone surveys may provide an alternative method by which population-based influenza morbidity information can be gathered.

Perceptions matter: beliefs about influenza vaccine and vaccination behavior among elderly white, black and Hispanic Americans.

BACKGROUND: Knowledge and beliefs about influenza vaccine that differ across racial or ethnic groups may promote racial or ethnic disparities in vaccination. OBJECTIVE: To identify associations between vaccination behavior and personal beliefs about influenza vaccine by race or ethnicity and education levels among the U.S. elderly population. METHODS: Data from a national telephone survey conducted in 2004 were used for this study. Responses for 3875 adults ≥ 65 years of age were analyzed using logistic regression methods. RESULTS: Racial and ethnic differences in beliefs were observed. For example, whites were more likely to believe influenza vaccine is very effective in preventing influenza compared to blacks and Hispanics (whites, 60%; blacks, 47%, and Hispanics, 51%, p<0.01). Among adults who believed the vaccine is very effective, self-reported vaccination was substantially higher across all racial/ethnic groups (whites, 93%; blacks, 76%; Hispanics, 78%) compared to adults who believed the vaccine was only somewhat effective (whites 67%; blacks 61%, Hispanics 61%). Also, vaccination coverage differed by education level and personal beliefs of whites, blacks, and Hispanics. CONCLUSIONS: Knowledge and beliefs about influenza vaccine may be important determinants of influenza vaccination among racial/ethnic groups. Strategies to increase coverage should highlight the burden of influenza disease in racial and ethnic populations, the benefits and safety of vaccinations and personal vulnerability to influenza disease if not vaccinated. For greater effectiveness, factors associated with the education levels of some communities may need to be considered when developing or implementing new strategies that target specific racial or ethnic groups.

Support for seasonal influenza vaccination requirements among US healthcare personnel.

OBJECTIVE: To measure support for seasonal influenza vaccination requirements among US healthcare personnel (HCP) and its associations with attitudes regarding influenza and influenza vaccination and self-reported coverage by existing vaccination requirements. DESIGN: Between June 1 and June 30, 2010, we surveyed a sample of US HCP ([Formula: see text]) recruited using an existing probability-based online research panel of participants representing the US general population as a sampling frame. SETTING: General community. PARTICIPANTS: Eligible HCP who (1) reported having worked as medical doctors, health technologists, healthcare support staff, or other health practitioners or who (2) reported having worked in hospitals, ambulatory care facilities, long-term care facilities, or other health-related settings. METHODS: We analyzed support for seasonal influenza vaccination requirements for HCP using proportion estimation and multivariable probit models. RESULTS: A total of 57.4% (95% confidence interval, 53.3%-61.5%) of US HCP agreed that HCP should be required to be vaccinated for seasonal influenza. Support for mandatory vaccination was statistically significantly higher among HCP who were subject to employer-based influenza vaccination requirements, who considered influenza to be a serious disease, and who agreed that influenza vaccine was safe and effective. CONCLUSIONS: A majority of HCP support influenza vaccination requirements. Moreover, providing HCP with information about the safety of influenza vaccination and communicating that immunization of HCP is a patient safety issue may be important for generating staff support for influenza vaccination requirements.

Influenza A (H1N1) 2009 monovalent vaccination among adults with asthma, U.S., 2010.

BACKGROUND: The 2009 pandemic influenza A (H1N1) virus (2009 H1N1) was first identified in April 2009 and quickly spread around the world. The first doses of influenza A (H1N1) 2009 monovalent vaccine (2009 H1N1 vaccine) became available in the U.S. in early October 2009. Because people with asthma are at increased risk of complications from influenza, people with asthma were included among the initial prioritized groups. PURPOSE: To evaluate 2009 H1N1 vaccination coverage and identify factors independently associated with vaccination among adults with asthma in the U.S. METHODS: Data from the 2009-2010 BRFSS (Behavioral Risk Factor Surveillance System) influenza supplemental survey were used; responses from March through June 2010 were analyzed to estimate vaccination levels of 2009 H1N1 vaccine among respondents aged 25-64 years with asthma. Multivariable logistic regression and predictive marginal models were performed to identify factors independently associated with vaccination. RESULTS: Among adults aged 25-64 years with asthma, 25.5% (95% CI=23.9%, 27.2%) received the 2009 H1N1 vaccination. Vaccination coverage ranged from 9.9% (95% CI=6.4%, 15.1%) in Mississippi to 46.1% (95% CI=33.3%, 61.2%) in Maine. Characteristics independently associated with an increased likelihood of vaccination among adults with asthma were as follows: had a primary doctor, had other high-risk conditions, and received seasonal influenza vaccination in the 2009-2010 season. CONCLUSIONS: Vaccination coverage among adults aged 25-64 years with asthma was only 25.5% and varied widely by state and demographic characteristics. National and state-specific 2009 H1N1 vaccination coverage data for adults with asthma are useful for evaluating the vaccination campaign and for planning and implementing strategies for increasing vaccination coverage in possible future pandemics.

Influenza vaccination coverage among pregnant women--National 2009 H1N1 Flu Survey (NHFS).

We sought to describe vaccination with influenza A (H1N1) 2009 monovalent (2009 H1N1) and trivalent seasonal (seasonal) vaccines among pregnant women during the 2009 through 2010 influenza season. A national H1N1 flu survey was conducted April through June 2010. The 2009 H1N1 and seasonal vaccination coverage estimates were 45.7% and 32.1%, respectively, among pregnant women aged 18-49 years. Receipt of a health care provider's recommendation for vaccination, perceived effectiveness of influenza vaccinations, and perceived high chance of influenza infection were independently associated with higher 2009 H1N1 and seasonal vaccination coverage. Pregnancy during October 2009 through January 2010 was independently associated with higher 2009 H1N1 vaccination coverage. The 2009 H1N1 vaccination level among pregnant women was higher than the seasonal vaccination level during the 2009 through 2010 season; it was also higher than vaccination among nonpregnant women with and without high-risk conditions. Health care providers and public health messaging played important roles in influencing vaccination behavior.

Barriers to early uptake of tetanus, diphtheria and acellular pertussis vaccine (Tdap) among adults-United States, 2005-2007.

BACKGROUND: The tetanus, diphtheria and acellular pertussis vaccine (Tdap) was recommended by the Advisory Committee on Immunization Practices (ACIP) for U.S. adults in 2005. Our objective was to identify barriers to early uptake of Tdap among adult populations. METHODS: The 2007 National Immunization Survey (NIS)-Adult was a telephone survey sponsored by the Centers for Disease Control and Prevention (CDC). Immunization information was collected for persons aged ≥18 years on all ACIP-recommended vaccines. A weighted analysis accounted for the complex survey design and non-response. RESULTS: Overall, 3.6% of adults aged 18-64 years reported receipt of a Tdap vaccination. Of unvaccinated respondents, 18.8% had heard of Tdap, of which 9.4% reported that a healthcare provider had recommended it. A low perceived risk of contracting pertussis was the single most common reason for either not vaccinating with Tdap or being unwilling to do so (44.7%). Most unvaccinated respondents (81.8%) indicated a willingness to receive Tdap if it was recommended by a provider. CONCLUSIONS: During the first two years of availability, Tdap uptake was likely inhibited by a low collective awareness of Tdap and a low perceived risk of contracting pertussis among U.S. adults, as well as a paucity of provider-to-patient vaccination recommendations. Significant potential exists for improved coverage, as many adults were receptive to vaccination.

Influenza, hepatitis B, and tetanus vaccination coverage among health care personnel in the United States.

BACKGROUND: Health care personnel (HCP) are at risk for exposure to and possible transmission of vaccine-preventable diseases. Maintenance of immunity is an essential prevention practice for HCP. We assessed the recent influenza, hepatitis B, and tetanus vaccination coverage among HCP in the United States. METHODS: We analyzed data from the 2007 National Immunization Survey-Adult restricted to survey respondents aged 18 to 64 years. Influenza, hepatitis B, and tetanus vaccination coverage levels among HCP were assessed. Multivariable logistic regression was conducted to assess factors independently associated with receipt of vaccination among HCP. RESULTS: Among HCP aged 18 to 64 years, 46.7% (95% confidence interval [CI]: 39.6%-53.8%) had received influenza vaccination for the 2006-2007 season, and 70.4% (95% CI: 63.9%-76.1%) received tetanus vaccination in the past 10 years; 61.7% (95% CI: 52.5%-70.2%) had received 3 or more doses of hepatitis B vaccination among HCP aged 18 to 49 years. Multiple logistic regression analysis showed that being married was associated with influenza vaccination coverage, higher education level was associated with hepatitis B vaccination coverage, and younger age was significantly associated with tetanus vaccination among HCP. Among those HCP who did not receive influenza vaccination, the most common reason reported was respondent concerns about vaccine safety and adverse effects. CONCLUSION: By 2007, influenza and hepatitis B vaccination coverage among HCP remained well below the Healthy People 2010 objectives. Tetanus vaccination level was 70%, and this study provided a baseline data for tetanus vaccination among HCP. Innovative strategies are needed to further increase vaccination coverage among HCP.

Herpes zoster vaccination among adults aged 60 years and older, in the U.S., 2008.

BACKGROUND: Shingles (herpes zoster [HZ]) is a localized, generally painful and debilitating disease that occurs most frequently among older adults. It is caused by reactivation of varicella-zoster virus. HZ causes substantial morbidity, especially among older adults. The vaccine to prevent HZ was approved by Food and Drug Administration and recommended by the Advisory Committee for Immunization Practices for people aged ≥60 years in 2006 (these recommendations were published in 2008). PURPOSE: To examine HZ vaccination among people aged ≥60 years in the U.S. in 2008. METHODS: Data from the 2008 National Health Interview Survey among people aged ≥60 years were analyzed in 2010. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with HZ vaccination. Potential missed opportunities also were assessed. RESULTS: By 2008, only 6.7% (95% CI=5.9%, 7.6%) of adults aged ≥60 years reported having had HZ vaccination. The level of HZ vaccination coverage was lower (4.7%) among people aged 60-64 years compared to people aged 65-74 years (7.4%); 75-84 years (7.6%); and ≥85 years (8.2%). Coverage was statistically higher for non-Hispanic whites (7.6%) compared with non-Hispanic blacks (2.5%) and Hispanics (2.1%). Among people aged ≥60 years who reported never receiving HZ vaccination, 95.1% reported at least one missed opportunity to be vaccinated. People more likely to report ever having been vaccinated were older, female, non-Hispanic white, married, more educated, and reporting received influenza vaccination in the past year. CONCLUSIONS: By 2008, HZ vaccination coverage was 6.7%. The coverage level was low among all groups, but it was lowest among minority groups. Increased efforts are needed to remove barriers and to enable HZ vaccination among all adults aged ≥60 years.

Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010.

This report updates the 2009 recommendations by CDC's Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine for the prevention and control of influenza (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2009;58[No. RR-8] and CDC. Use of influenza A (H1N1) 2009 monovalent vaccine---recommendations of the Advisory Committee on Immunization Practices [ACIP], 2009. MMWR 2009;58:[No. RR-10]). The 2010 influenza recommendations include new and updated information. Highlights of the 2010 recommendations include 1) a recommendation that annual vaccination be administered to all persons aged >or=6 months for the 2010-11 influenza season; 2) a recommendation that children aged 6 months--8 years whose vaccination status is unknown or who have never received seasonal influenza vaccine before (or who received seasonal vaccine for the first time in 2009-10 but received only 1 dose in their first year of vaccination) as well as children who did not receive at least 1 dose of an influenza A (H1N1) 2009 monovalent vaccine regardless of previous influenza vaccine history should receive 2 doses of a 2010-11 seasonal influenza vaccine (minimum interval: 4 weeks) during the 2010--11 season; 3) a recommendation that vaccines containing the 2010-11 trivalent vaccine virus strains A/California/7/2009 (H1N1)-like (the same strain as was used for 2009 H1N1 monovalent vaccines), A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens be used; 4) information about Fluzone High-Dose, a newly approved vaccine for persons aged >or=65 years; and 5) information about other standard-dose newly approved influenza vaccines and previously approved vaccines with expanded age indications. Vaccination efforts should begin as soon as the 2010-11 seasonal influenza vaccine is available and continue through the influenza season. These recommendations also include a summary of safety data for U.S.-licensed influenza vaccines. These recommendations and other information are available at CDC's influenza website (http://www.cdc.gov/flu); any updates or supplements that might be required during the 2010-11 influenza season also will be available at this website. Recommendations for influenza diagnosis and antiviral use will be published before the start of the 2010-11 influenza season. Vaccination and health-care providers should be alert to announcements of recommendation updates and should check the CDC influenza website periodically for additional information.

Behavior and beliefs about influenza vaccine among adults aged 50-64 years.

OBJECTIVE: To examine demographics and beliefs about influenza disease and vaccine that may be associated with influenza vaccination among 50- to 64-year-olds. METHODS: A national sample of adults aged 50-64 years surveyed by telephone. RESULTS: Variables associated with receiving influenza vaccination included age, education level, recent doctor visit, and beliefs about vaccine effectiveness and vaccine safety. Beliefs about influenza vaccination varied by race/ethnicity, age, education, and gender. CONCLUSION: The finding of demographic differences in beliefs suggests that segmented communication messages designed for specific demographic subgroups may help to increase influenza vaccination coverage.

Influenza vaccination among adults with asthma findings from the 2007 BRFSS survey.

BACKGROUND: Asthma prevalence among U.S. adults is estimated to be 6.7%. People with asthma are at increased risk of complications from influenza. Influenza vaccination of adults and children with asthma is recommended by the Advisory Committee on Immunization Practices. The Healthy People 2010 Objectives call for annual influenza vaccination of at least 60% of adults aged 18-64 years with asthma and other conditions associated with an increased risk of complications from influenza. PURPOSE: To assess influenza vaccination coverage among adults with asthma in the United States. METHODS: Data from the 2007 Behavioral Risk Factor Surveillance System restricted to individuals interviewed during February through August were analyzed in 2008 to estimate national and state prevalence of self-reported receipt of influenza vaccination among respondents aged 18-64 years with asthma. Logistic regression provided predictive marginal vaccination coverage for each covariate, adjusted for demographic and access to care characteristics. RESULTS: Among adults aged 18-64 years with asthma, influenza vaccination coverage was 39.9% (95% CI=38.3%, 41.5%) during the 2006-2007 season (coverage ranged from 26.9% [95% CI=19.8%, 35.3%] in California to 53.3% [95% CI=42.8%, 63.6%] in Tennessee). Influenza vaccination coverage was 33.9% (95% CI=31.9%, 35.9%) for adults aged 18-49 years with asthma compared to 54.7% (95% CI=52.4%, 57.0%) for adults aged 50-64 years with asthma. Among people aged 18-64 years, vaccination coverage was 28.8% among those without asthma. People with asthma who had an increased likelihood of vaccination were aged 50-64 years, female, non-Hispanic white, and had diabetes, activity limitations, health insurance, a regular healthcare provider, routine checkup in the previous year, and formerly smoked or never smoked. CONCLUSIONS: Influenza vaccination coverage continues to be below the national objective of 60% for people aged 18-64 years with asthma as a high-risk condition. Increased state and national efforts are needed to improve influenza vaccination levels among this population and particularly among those aged 18-49 years.

Hepatitis A vaccination coverage among adults aged 18-49 years in the United States.

BACKGROUND: Hepatitis A is the most common type of hepatitis reported in the United States. Prior to hepatitis A vaccine introduction in 1996, hepatitis A incidence followed a cyclic pattern with peak incidence occurring every 10-15 years. During 1980-1995, between 22,000 and 36,000 hepatitis A cases were reported annually. Since 1996, hepatitis A vaccination recommendations have included adults at risk for infection and children living in communities with the highest disease rates. This study provides the first national estimates of self-reported hepatitis A vaccination coverage among persons aged 18-49 years in the United States. METHODS: We analyzed the 2007 National Immunization Survey-Adult (NIS-Adult) data with restrictions to individuals aged 18-49 years. National estimates of hepatitis A vaccination coverage were calculated based on self-report and multivariable logistic regression analysis was used to identify factors independently associated with hepatitis A vaccination status. RESULTS: Among adults aged 18-49 years, 12.1% (95% confidence interval, CI=9.9-14.8%) had received two or more doses of hepatitis A vaccine in 2007. Hepatitis A vaccination coverage was significantly higher among adults aged 18-29 years (15.6%) and adults aged 30-39 years (12.9%) compared with adults aged 40-49 years (8.3%). Coverage was significantly lower for Hispanics (7.1%) compared with non-Hispanic whites (12.5%). Characteristics independently associated with a higher likelihood of hepatitis A vaccination among persons aged 18-49 years included younger age groups, persons at or above poverty level, persons with public medical insurance, and persons who received influenza vaccination in the past season. CONCLUSIONS: In 2007, self-reported hepatitis A vaccination coverage among adults aged 18-49 years was 12.1%. These data provide the first national hepatitis A vaccination coverage estimates among adults and are very important in planning and implementing strategies for increasing hepatitis A vaccination coverage among adults at risk for hepatitis A.

Human papillomavirus (HPV) awareness and vaccination initiation among women in the United States, National Immunization Survey-Adult 2007.

OBJECTIVES: To report awareness of human papillomavirus (HPV) and HPV vaccine among women aged 18-49 years and, for recommended women aged 18-26 years, estimate initiation of HPV vaccination and describe factors associated with vaccination initiation among a national sample. METHODS: Data were analyzed from the National Immunization Survey-Adult, a nationally representative telephone survey conducted May-August 2007. Questions were asked about awareness of HPV and HPV vaccine and vaccine receipt. RESULTS: A total of 1102 women aged 18-49 years were interviewed, 168 were aged 18-26 years. Overall, awareness of HPV (84.3%) and of HPV vaccine (78.9%) were high. Among women 18-26 years of age, vaccination initiation (> or =1 dose) was 10%. Factors associated with vaccination included not being married, living > or =200% of the federal poverty index, having health insurance, and vaccination with hepatitis B vaccine. HPV vaccination initiation among women aged 27-49 years was 1%. CONCLUSIONS: Awareness of HPV and HPV vaccine were high. Two to 5 months after national HPV vaccination recommendations were published, one in ten women 18-26 years old had initiated the HPV vaccine series. Women at a higher socio-economic level were more likely to receive the vaccination. Vaccination initiation and completion will likely increase over the next years. Monitoring uptake is important to identify sub-groups that may not be receiving the vaccination.

Herpes zoster vaccination among adults aged 60 years or older in the United States, 2007: uptake of the first new vaccine to target seniors.

BACKGROUND: Approximately one million new cases of shingles (herpes zoster [HZ]), a severely painful and debilitating disease caused by reactivation of varicella-zoster virus (VZV), occur in the United States each year. HZ incidence increases with age, especially after age 50. A vaccine to prevent HZ and its sequelae was licensed in May 2006 for those aged 60 years or older, making it the first new vaccine targeted to this age group in many years. In October 2006 the Advisory Committee on Immunization Practices (ACIP) recommended HZ vaccination of persons aged > or =60 years; these recommendations were published in 2008. We examined HZ vaccination coverage among persons aged > or =60 years in the U.S. in 2007, and evaluated factors affecting the uptake of HZ vaccine in this population. METHODS: Data from the 2007 National Immunization Survey-Adult (NIS-Adult) restricted to individuals aged > or =60 years were analyzed using SUDAAN software to estimate national HZ vaccination coverage, and reasons for not receiving the HZ vaccine. We used multivariable logistic regression analysis to identify factors independently associated with HZ vaccination. RESULTS: Of 3662 respondents, 1.9% (95% confidence interval=1.3%, 2.8%) reported having received the HZ vaccine. A total of 72.9% of respondents were unaware of the HZ vaccine but 77.8% stated that they would accept HZ vaccination if their doctor recommended it. Of the remaining 556 respondents, key reasons reported for not accepting HZ vaccine included 'vaccination not needed' (34.8%), 'not at risk' (12.5%), and 'don't trust in doctors or medicine' (9.5%). CONCLUSIONS: Soon after its availability in the United States, coverage among adults recommended to receive the HZ vaccine was low. Our data provide evidence that the lack of patient awareness and of physician recommendations were barriers to vaccine uptake.

U.S. Healthcare personnel and influenza vaccination during the 2004-2005 vaccine shortage.

BACKGROUND: Healthcare personnel with direct patient contact were prioritized for influenza vaccination during the 2004-2005 vaccine shortage. Data about vaccination coverage among healthcare personnel during vaccine shortages are limited. METHODS: Behavioral Risk Factor Surveillance System 2005 data were analyzed in 2007 for a sample of healthcare facility workers (HCFW) aged 18-64 with (n=3456) and without (n=1153) direct patient contact and non-HCFWs (n=39,405). Chi-square tests and logistic regression were used to identify factors associated with influenza vaccination among HCFWs and to compare HCFWs with non-HCFWs with regard to the main reason for nonvaccination during the shortage. RESULTS: Vaccination coverage was 37% (SE +/- 3.1) among HCFWs with direct patient contact and 25% (SE +/- 5.7) among those without. In multivariate analysis, coverage was higher among HCFWs who were older, more educated, and with higher incomes and better access to health care. The reason most commonly reported by HCFWs and non-HCFWs for nonvaccination was the belief that they did not need vaccination (35% versus 40%, respectively; p<0.05). CONCLUSIONS: Even in a time of influenza-vaccine shortage, when most healthcare personnel were targeted for vaccination, their uptake of the vaccine remained suboptimal. Continued efforts are needed to develop effective interventions to improve the use of influenza vaccination among healthcare workers.

Status of influenza and pneumococcal vaccination among older American Indians and Alaska Natives.

OBJECTIVES: We sought to estimate the influenza and pneumococcal vaccination coverage among older American Indian and Alaska Native (AIAN) adults nationally and the impact of sociodemographic factors, variations by geographic region, and access to services on vaccination coverage. METHODS: We obtained our sample of 1981 AIAN and 179845 White respondents 65 years and older from Behavioral Risk Factor Surveillance System data from 2003 to 2005. Logistic regression provided predictive marginal vaccination coverage for each covariate and adjusted for demographic characteristics and access to care. RESULTS: Unadjusted influenza coverage estimates were similar between AIAN and White respondents (68.1% vs 69.5%), but pneumococcal vaccination was lower among AIAN respondents (58.1% vs 67.2%; P<.01). After multivariable adjustment for sociodemographic characteristics, self-reported coverage for both vaccines was statistically similar between AIAN and White adults. CONCLUSIONS: Although there was no disparity in influenza coverage, pneumococcal coverage was lower among AIAN than among White respondents, probably because of sociodemographic risk factors. Regional variation indicates a need to monitor coverage and target interventions to reduce disparities within geographically and culturally diverse subpopulations of AIAN persons.