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Worksite: Seasonal Influenza Vaccinations Using Interventions with On-Site, Reduced Cost, Actively Promoted Vaccinations – non-Healthcare Workers


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 5 studies (search period through March 2008). The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to worksite health promotion.


On-site vaccination interventions principally attempt to enhance access to the vaccine for workers and attempt to address many of the identified barriers to vaccine uptake. 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.

Summary of Results

Five studies with six total study arms (intervention comparisons) qualified for the review and examined changes in vaccination coverage or worker productivity.

  • Evaluated interventions showed median increases in vaccination coverage of:
    • 21 percentage points (2 study arms with comparison groups)
    • 38 percentage points (4 studies with no comparison group)

Summary of Economic Evidence

One study from the U.S. provided economic information for influenza vaccination programs in non-healthcare worksites. Conclusions cannot be made from this small and incomplete body of evidence. Monetary values are reported in 2007 U.S dollars.

  • The cost of the vaccination program was $31.95 per person, and did not include the promotional campaign cost.
  • The economic net benefit per person was $129—$53 in averted productivity losses due to work absences, and $76 in averted healthcare cost due to influenza.


Results from the review are applicable to workers in medium and large worksites.

Evidence Gaps

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

The following outlines evidence gaps for these interventions to promote seasonal influenza vaccinations among non-healthcare workers: on-site, reduced cost, actively promoted vaccinations; and actively promoted off-site vaccinations.

The primary questions that remain unanswered from this review relate to cost savings and the overall effectiveness of interventions with additional components like mobile carts or incentives. To address these issues and further the knowledge of the field of worksite influenza vaccination interventions, researchers must conduct rigorous, multi-year studies with concurrent comparison worksites that evaluate on-site, off-site, and other intervention approaches. Additionally, researchers should investigate the following:

  • How might the successes in increasing influenza vaccination coverage in the body of evidence for healthcare workers inform efforts in non-healthcare worksites?
  • What specific barriers, besides access, should implementers address with their interventions?
  • What might be the cost of presenteeism associated with influenza in the worksite, including, for example, the cost of injuries due to reduced alertness, the cost of reduced morale, and the cost of spreading infection to other workers?

Study Characteristics

  • Studies evaluated interventions with reduced cost, 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 large worksites (more than 500 workers).
  • Most studies were conducted in the United States, and one study was conducted in the Philippines.