title: Motivating factors for high rates of influenza vaccination among healthcare workers.
abstract: BACKGROUND
  Recent guidance from related regulatory agencies and medical societies supports mandatory vaccination of healthcare workers (HCW) against influenza. At St. Jude Children's Research Hospital, a pediatric oncology referral center, more than 90% of HCWs receive vaccine each year without a policy mandating immunization. Factors associated with HCW uptake of influenza vaccines have not previously been evaluated in a high compliance rate setting.
  
  
  METHODS
  A structured, anonymous, electronic questionnaire was distributed in August 2010 to employees (HCW and non-HCW). Demographics, prior receipt of influenza vaccines, reasons for acceptance or refusal of seasonal and 2009 H1N1 pandemic vaccine, and attitudes on mandatory vaccination were assessed.
  
  
  RESULTS
  95.0% of 925 HCWs and 63.1% of all 3227 qualifying employees responded to the survey. 93.8% and 75.2% of HCW reported receiving seasonal and 2009 H1N1 influenza vaccines, respectively, in the 2009-2010 season. Benefits to self and/or patients were cited as the most frequent reasons for accepting seasonal (83.5% and 78.3%, respectively) and 2009 H1N1 (85.9% and 81.1%, respectively) vaccination. 36.6% of HCWs opposed mandating influenza vaccination; 88.2% and 59.9% of whom reported receiving the seasonal and 2009 H1N1 influenza vaccines, respectively. Violation of freedom of choice and personal autonomy were the most frequently reported reasons for opposition.
  
  
  CONCLUSIONS
  In this cohort of HCWs with a high influenza vaccination rate, realistic assessments of the potential benefits of vaccination appear to have driven the choice to accept immunization. Despite this, mandating vaccination was viewed unfavorably by a significant minority of vaccinated individuals. Employee concerns over autonomy should be addressed as institutions transition to mandatory vaccination policies.
authors.affiliation: Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, United States. Hana.Hakim@stjude.org
authors.forename: Hana
authors.initials: H
authors.lastname: Hakim
authors.forename: Aditya H
authors.initials: AH
authors.lastname: Gaur
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: McCullers
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control* / Q000821:virology; D008297:Male; D037141:Mandatory Programs; D008875:Middle Aged; D009042:Motivation; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines