title: Influenza immunization among Canadian health care personnel: a cross-sectional study.
abstract: BACKGROUND
  Influenza immunization coverage among Canadian health care personnel remains below national targets. Targeting this group is of particular importance given their elevated risk of influenza infection, role in transmission and influence on patients' immunization status. We examined influenza immunization coverage in health care personnel in Canada, reasons for not being immunized and the impact of "vaccinate-or-mask" influenza prevention policies.
  
  
  METHODS
  In this national cross-sectional study, we pooled data from the 2007 to 2014 cycles of the Canadian Community Health Survey and restricted it to respondents who reported a health care occupation. Using bootstrapped survey weights, we examined immunization coverage by occupation and by presence of vaccinate-or-mask policies, and reasons for not being immunized. We used modified Poisson regression to estimate the prevalence ratio (PR) of influenza immunization for health care occupations compared with the general working population.
  
  
  RESULTS
  For all survey cycles combined, 50% of 18 446 health care personnel reported receiving seasonal influenza immunization during the previous 12 months, although this varied by occupation type (range 4%-72%). Compared with the general working population, family physicians and general practitioners were most likely to be immunized (PR 3.15, 95% confidence interval [CI] 2.76-3.59), whereas chiropractors, midwives and practitioners of natural healing were least likely (PR 0.17, 95% CI 0.10-0.30). Among those who were not immunized, the most frequently cited reason was the belief that influenza immunization is unnecessary. Introduction of vaccinate-or-mask policies was associated with increased influenza immunization among health care personnel.
  
  
  CONCLUSIONS
  Health care personnel are more likely to be immunized against influenza than the general working population, but coverage remains suboptimal overall, and we observed wide variation by occupation type. More efforts are needed to target specific health care occupations with low immunization coverage.
authors.affiliation: Dalla Lana School of Public Health (Buchan, Kwong), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; Institute for Clinical Evaluative Sciences (Kwong), Toronto, Ont.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Buchan
authors.affiliation: Dalla Lana School of Public Health (Buchan, Kwong), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; Institute for Clinical Evaluative Sciences (Kwong), Toronto, Ont.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Kwong