Low Influenza Vaccination Rates Among Child Care Workers in the United States: Assessing Knowledge, Attitudes, and Behaviors

Influenza can spread quickly among children and caregivers in child day care settings. Vaccination is the most effective method
to prevent influenza. We determined 2009 pandemic influenza A (H1N1) (pH1N1) and seasonal influenza vaccination rates during
the 2009–2010 influenza season among child care center employees, assessed knowledge and attitudes regarding the vaccines,
and determined factors associated with vaccine receipt. Using a cross-sectional study design, from January 30–March 1, 2010,
we surveyed 384 (95%) of 403 employees at 32 licensed child centers in the United States about personal and work characteristics,
vaccine receipt, and knowledge and attitudes regarding each vaccine. Forty-five (11%) and eighty five (22%) respondents reported
receiving the pH1N1 and seasonal influenza vaccines, respectively. The most common reasons cited for not getting either vaccine
were “I don’t think I need the vaccine,” “I don’t think the vaccine will keep me from getting the flu,” and “the vaccine is
not safe.” Factors independently associated with receipt of either vaccine included belief in its efficacy, having positive
attitudes towards it, and feeling external pressure to get it. Child care center employees had low rates of pH1N1 and seasonal
influenza vaccination largely due to misconceptions about the need for and efficacy of the vaccine. Public health messages
should address misconceptions about vaccines, and employers should consider methods to maximize influenza vaccination of employees
as part of a comprehensive influenza prevention program.