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Interventions to Promote Seasonal Influenza Vaccinations among Healthcare Workers

Interventions to increase uptake of flu vaccines in healthcare workers (HCW) involve making vaccines available to workers and announcing this availability using things such as newsletters, e-mails, or paycheck inserts.

Vaccines may be offered:

  • On-site or off-site
  • At cost, reduced cost, or no cost
  • With health education and mobile units
  • In clinics
  • At multiple locations

Summary of Task Force Recommendations and Findings

The Community Preventive Services Task Force recommends interventions with on-site, free, and actively promoted influenza vaccinations, when implemented alone or as part of a multicomponent intervention, based on strong evidence of their effectiveness in increasing influenza vaccination coverage among healthcare workers when implemented alone or as part of a multicomponent intervention.

The Task Force recommends interventions with on-site, free, and actively promoted influenza vaccinations based on sufficient evidence of their effectiveness in decreasing cases of influenza among healthcare workers and patients when implemented alone or as part of a multicomponent intervention.

The Task Force finds insufficient evidence to determine the effectiveness of interventions with actively promoted, off-site influenza vaccinations to increase influenza vaccination coverage or productivity among healthcare workers or to reduce illness.

Read the full Task Force Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

Interventions with On-Site, Free, Actively Promoted Seasonal Influenza Vaccinations

On-site, free, and actively promoted influenza vaccination interventions provide access to vaccinations for workers at the healthcare facility in which recipients normally work and at no cost to the workers. They announce vaccination availability through formal worksite announcements, such as in newsletters, e-mails, or paycheck inserts. By providing the vaccination at the worksite, employers reduce the temporal, geographic, and financial barriers that can prevent a worker from getting vaccinated.

Results from the Systematic Review

Forty-five studies qualified for the review and examined changes in vaccination coverage, changes in influenza cases, or worker productivity.

  • Change in vaccination coverage: median increase of 21.0 percentage points (interquartile interval: 11 to 34 percentage points; 41 studies)
  • Change in influenza cases:
    • Among patients: median relative decrease of 11.3% (3 studies)
    • Nosocomial infections (acquired during visits to hospitals or other healthcare settings): median relative decrease of 78.0% (4 studies)
  • Change in worker productivity was not reported in the qualifying studies.
  • All 45 studies evaluated interventions with free, on-site, actively promoted influenza vaccinations alone and when combined with additional interventions including provision of information, efforts to enhance access, activities to change attitudes and norms, and policy changes.
  • Studies evaluated interventions conducted in medium and large hospitals, and in long-term care facilities.
  • Studies were conducted mostly in the United States, Europe, and Canada; however, the body of evidence included studies from Singapore, Brazil, South Korea, and Australia.

Interventions with Actively Promoted, Off-Site Seasonal Influenza Vaccinations

Interventions with actively promoted, off-site influenza vaccinations encourage workers in healthcare worksites to obtain influenza vaccinations in a location other than that in which they normally work using any of a variety of approaches. These include providing vouchers or leave time, conducting health education sessions, and sending reminders about the vaccination. The intervention must be promoted through formal worksite announcements, such as newsletters, e-mails, paycheck inserts, or posters in the worksite and may include additional components.

Results of the Systematic Reviews

We identified one study to be included in this review. This was a randomized, controlled trial that evaluated the effectiveness of health education approaches to increase influenza vaccinations off-site with primary care providers (as opposed to the entire HCW population). The authors reported small, non-significant findings when comparing the treatment and control groups: 21.9 percent versus 21.0 percent (p=.91) among primary healthcare teams and 10.2 percent versus 5.6 percent (p=.34) among nursing homes.

These results are based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic reviews, other research, and public health practice and policy related to worksite health promotion and influenza vaccination.

Supporting Materials

Publication Status

Full peer-reviewed articles of this systematic review will be posted on the Community Guide website when published. Subscribe External Web Site Icon to be notified when we post these publications or other materials. See our library for previous Community Guide publications on this and other topics.


The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Interventions to promote seasonal influenza vaccinations among healthcare workers. Last updated: MM/DD/YYYY.

Review completed: June 2008